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Wilkes NSG 526 Exam 2 Clinical Modalities
Advanced Psych Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed
Rationales | Pass Guaranteed – A+ Graded
[SECTION 1: Mood Disorders (Depression, Bipolar) — Questions 1-18]
Q1: A 45-year-old patient presents with a depressed mood, anhedonia, and significant weight
loss. The nurse practitioner (NP) determines the patient meets the diagnostic criteria for Major
Depressive Disorder (MDD). According to DSM-5-TR criteria, which of the following symptom
clusters must be present to confirm this diagnosis?
A. Mood symptoms only, as they are the primary feature of MDD.
B. At least five symptoms, including either depressed mood or anhedonia, present for at least 2
weeks.
C. At least three symptoms present for at least 1 week, accompanied by psychotic features.
D. Persistent irritability for at least 6 months in the absence of depressive symptoms.
Correct Answer: B [CORRECT]
Correct Answer: B
Rationale: The DSM-5-TR mandates a diagnosis of Major Depressive Disorder requires at least
five of nine specific symptoms (SIG E CAPS) to be present during the same 2-week period,
representing a change from previous functioning; at least one of the symptoms must be either
depressed mood or anhedonia. Option A is incorrect because mood symptoms alone are
insufficient without the required total number of symptoms. Option C is incorrect because MDD
requires five symptoms, not three, and duration must be 2 weeks, not necessarily requiring
psychosis. Option D describes a duration and presentation more consistent with Persistent
Depressive Disorder (Dysthymia) or a mood disorder secondary to a medical condition, rather
than acute MDD.
Q2: When assessing a patient with MDD using the mnemonic SIG E CAPS, which symptom is
represented by the letter "I"?
A. Insomnia
,2
B. Irritability
C. Indecisiveness
D. Interest loss (Anhedonia)
Correct Answer: D [CORRECT]
Correct Answer: D
Rationale: In the mnemonic SIG E CAPS used to recall the symptoms of depression, "I" stands
for Interest loss, also known as anhedonia, which is one of the two core symptoms required for
an MDD diagnosis. Option A (Insomnia) corresponds to "S" for Sleep changes. Option C
(Indecisiveness) falls under "C" for Concentration difficulties. Option B (Irritability) is a
symptom but is not specifically represented by the letter "I" in this standard mnemonic.
Q3: A 28-year-old female patient reports feeling "down in the dumps" for the past three years.
She states that while she can function at work, she never feels truly happy or engaged. She has
never experienced a period of mania or hypomania. Her symptoms are chronic but not severe
enough to meet the full criteria for Major Depressive Disorder at any given point. Which
diagnosis best fits this presentation?
A. Major Depressive Disorder, recurrent, moderate
B. Bipolar II Disorder
C. Persistent Depressive Disorder (Dysthymia)
D. Cyclothymic Disorder
Correct Answer: C [CORRECT]
Correct Answer: C
Rationale: Persistent Depressive Disorder (Dysthymia) is characterized by a depressed mood that
occurs for most of the day, for more days than not, for at least 2 years (1 year in
children/adolescents). While the patient may have periods of normal mood, these intervals do not
last longer than 2 months, and the symptoms are often less severe but more chronic than MDD.
Option A is incorrect because the chronicity and "low grade" nature point toward dysthymia
rather than recurrent episodes of severe MDD. Option B is incorrect as the patient has no history
of hypomania. Option D involves cycling hypomanic and depressive symptoms that do not meet
threshold criteria, which is not described here.
,3
Q4: A patient is diagnosed with Bipolar I Disorder. Which of the following criteria must have
occurred at least once in their lifetime to support this diagnosis?
A. A hypomanic episode of at least 4 days duration.
B. A major depressive episode lasting at least 2 weeks.
C. A manic episode lasting at least 1 week or requiring hospitalization.
D. A mixed episode featuring both manic and depressive symptoms daily.
Correct Answer: C [CORRECT]
Correct Answer: C
Rationale: Bipolar I Disorder is definitively characterized by the occurrence of at least one
lifetime manic episode, which is defined by a distinct period of abnormally and persistently
elevated, expansive, or irritable mood lasting at least 1 week or requiring hospitalization. While
depressive episodes are common, they are not strictly required for the diagnosis of Bipolar I
(though they are present in most cases). Option A describes Bipolar II (hypomania). Option B is
a feature of MDD or Bipolar II but is the defining criterion for Bipolar I. Option D ("mixed
episode") is no longer a separate diagnosis in DSM-5-TR but a specifier, though the presence of
mania remains the defining marker for Bipolar I.
Q5: A patient presents with symptoms of pressured speech, flight of ideas, and a decreased need
for sleep. They report engaging in high-risk sexual behavior during this period. The NP identifies
these symptoms as characteristic of a Manic Episode. Which of the following is an additional
diagnostic criterion for mania?
A. The symptoms cause significant impairment or hospitalization.
B. The episode must be preceded by a major depressive episode.
C. There must be a clear genetic link to a first-degree relative.
D. The symptoms must be attributable to the physiological effects of a substance.
Correct Answer: A [CORRECT]
Correct Answer: A
, 4
Rationale: For a Manic Episode to be diagnosed, the disturbance must cause significant
impairment in social or occupational functioning or necessitate hospitalization, or there are
psychotic features. Option B is incorrect because, while depression often follows, it is not a
criterion for the manic episode itself. Option C is incorrect because family history supports a
diagnosis but is not a diagnostic criterion. Option D describes a substance-induced disorder,
which actually excludes a diagnosis of Bipolar Disorder.
Q6: When differentiating Bipolar I from Bipolar II Disorder, what is the primary distinction?
A. Bipolar I involves hypomania, while Bipolar II involves mania.
B. Bipolar I involves mania, while Bipolar II involves hypomania.
C. Bipolar II includes psychotic features, whereas Bipolar I does not.
D. Bipolar I is treated only with psychotherapy, while Bipolar II requires medication.
Correct Answer: B [CORRECT]
Correct Answer: B
Rationale: The primary distinction is the nature of the "high" mood: Bipolar I requires a full
Manic Episode, whereas Bipolar II requires a Hypomanic Episode (at least 4 days) and a Major
Depressive Episode, without ever having a full Manic Episode. Option A is the opposite of the
correct definitions. Option C is incorrect because psychotic features can occur in both disorders,
though more common in Bipolar I mania. Option D is incorrect as both are biologically based
conditions typically requiring pharmacotherapy alongside psychotherapy.
Q7: A patient with a history of depression presents with elevated mood and increased energy for
the past 5 days. He is functioning well at work and claims he has never felt better. He denies any
psychotic symptoms or dangerous behavior. He states this has happened once before. What is the
most likely diagnosis?
A. Bipolar I Disorder
B. Bipolar II Disorder
C. Cyclothymic Disorder
D. Substance-Induced Mania
Correct Answer: B [CORRECT]
Wilkes NSG 526 Exam 2 Clinical Modalities
Advanced Psych Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed
Rationales | Pass Guaranteed – A+ Graded
[SECTION 1: Mood Disorders (Depression, Bipolar) — Questions 1-18]
Q1: A 45-year-old patient presents with a depressed mood, anhedonia, and significant weight
loss. The nurse practitioner (NP) determines the patient meets the diagnostic criteria for Major
Depressive Disorder (MDD). According to DSM-5-TR criteria, which of the following symptom
clusters must be present to confirm this diagnosis?
A. Mood symptoms only, as they are the primary feature of MDD.
B. At least five symptoms, including either depressed mood or anhedonia, present for at least 2
weeks.
C. At least three symptoms present for at least 1 week, accompanied by psychotic features.
D. Persistent irritability for at least 6 months in the absence of depressive symptoms.
Correct Answer: B [CORRECT]
Correct Answer: B
Rationale: The DSM-5-TR mandates a diagnosis of Major Depressive Disorder requires at least
five of nine specific symptoms (SIG E CAPS) to be present during the same 2-week period,
representing a change from previous functioning; at least one of the symptoms must be either
depressed mood or anhedonia. Option A is incorrect because mood symptoms alone are
insufficient without the required total number of symptoms. Option C is incorrect because MDD
requires five symptoms, not three, and duration must be 2 weeks, not necessarily requiring
psychosis. Option D describes a duration and presentation more consistent with Persistent
Depressive Disorder (Dysthymia) or a mood disorder secondary to a medical condition, rather
than acute MDD.
Q2: When assessing a patient with MDD using the mnemonic SIG E CAPS, which symptom is
represented by the letter "I"?
A. Insomnia
,2
B. Irritability
C. Indecisiveness
D. Interest loss (Anhedonia)
Correct Answer: D [CORRECT]
Correct Answer: D
Rationale: In the mnemonic SIG E CAPS used to recall the symptoms of depression, "I" stands
for Interest loss, also known as anhedonia, which is one of the two core symptoms required for
an MDD diagnosis. Option A (Insomnia) corresponds to "S" for Sleep changes. Option C
(Indecisiveness) falls under "C" for Concentration difficulties. Option B (Irritability) is a
symptom but is not specifically represented by the letter "I" in this standard mnemonic.
Q3: A 28-year-old female patient reports feeling "down in the dumps" for the past three years.
She states that while she can function at work, she never feels truly happy or engaged. She has
never experienced a period of mania or hypomania. Her symptoms are chronic but not severe
enough to meet the full criteria for Major Depressive Disorder at any given point. Which
diagnosis best fits this presentation?
A. Major Depressive Disorder, recurrent, moderate
B. Bipolar II Disorder
C. Persistent Depressive Disorder (Dysthymia)
D. Cyclothymic Disorder
Correct Answer: C [CORRECT]
Correct Answer: C
Rationale: Persistent Depressive Disorder (Dysthymia) is characterized by a depressed mood that
occurs for most of the day, for more days than not, for at least 2 years (1 year in
children/adolescents). While the patient may have periods of normal mood, these intervals do not
last longer than 2 months, and the symptoms are often less severe but more chronic than MDD.
Option A is incorrect because the chronicity and "low grade" nature point toward dysthymia
rather than recurrent episodes of severe MDD. Option B is incorrect as the patient has no history
of hypomania. Option D involves cycling hypomanic and depressive symptoms that do not meet
threshold criteria, which is not described here.
,3
Q4: A patient is diagnosed with Bipolar I Disorder. Which of the following criteria must have
occurred at least once in their lifetime to support this diagnosis?
A. A hypomanic episode of at least 4 days duration.
B. A major depressive episode lasting at least 2 weeks.
C. A manic episode lasting at least 1 week or requiring hospitalization.
D. A mixed episode featuring both manic and depressive symptoms daily.
Correct Answer: C [CORRECT]
Correct Answer: C
Rationale: Bipolar I Disorder is definitively characterized by the occurrence of at least one
lifetime manic episode, which is defined by a distinct period of abnormally and persistently
elevated, expansive, or irritable mood lasting at least 1 week or requiring hospitalization. While
depressive episodes are common, they are not strictly required for the diagnosis of Bipolar I
(though they are present in most cases). Option A describes Bipolar II (hypomania). Option B is
a feature of MDD or Bipolar II but is the defining criterion for Bipolar I. Option D ("mixed
episode") is no longer a separate diagnosis in DSM-5-TR but a specifier, though the presence of
mania remains the defining marker for Bipolar I.
Q5: A patient presents with symptoms of pressured speech, flight of ideas, and a decreased need
for sleep. They report engaging in high-risk sexual behavior during this period. The NP identifies
these symptoms as characteristic of a Manic Episode. Which of the following is an additional
diagnostic criterion for mania?
A. The symptoms cause significant impairment or hospitalization.
B. The episode must be preceded by a major depressive episode.
C. There must be a clear genetic link to a first-degree relative.
D. The symptoms must be attributable to the physiological effects of a substance.
Correct Answer: A [CORRECT]
Correct Answer: A
, 4
Rationale: For a Manic Episode to be diagnosed, the disturbance must cause significant
impairment in social or occupational functioning or necessitate hospitalization, or there are
psychotic features. Option B is incorrect because, while depression often follows, it is not a
criterion for the manic episode itself. Option C is incorrect because family history supports a
diagnosis but is not a diagnostic criterion. Option D describes a substance-induced disorder,
which actually excludes a diagnosis of Bipolar Disorder.
Q6: When differentiating Bipolar I from Bipolar II Disorder, what is the primary distinction?
A. Bipolar I involves hypomania, while Bipolar II involves mania.
B. Bipolar I involves mania, while Bipolar II involves hypomania.
C. Bipolar II includes psychotic features, whereas Bipolar I does not.
D. Bipolar I is treated only with psychotherapy, while Bipolar II requires medication.
Correct Answer: B [CORRECT]
Correct Answer: B
Rationale: The primary distinction is the nature of the "high" mood: Bipolar I requires a full
Manic Episode, whereas Bipolar II requires a Hypomanic Episode (at least 4 days) and a Major
Depressive Episode, without ever having a full Manic Episode. Option A is the opposite of the
correct definitions. Option C is incorrect because psychotic features can occur in both disorders,
though more common in Bipolar I mania. Option D is incorrect as both are biologically based
conditions typically requiring pharmacotherapy alongside psychotherapy.
Q7: A patient with a history of depression presents with elevated mood and increased energy for
the past 5 days. He is functioning well at work and claims he has never felt better. He denies any
psychotic symptoms or dangerous behavior. He states this has happened once before. What is the
most likely diagnosis?
A. Bipolar I Disorder
B. Bipolar II Disorder
C. Cyclothymic Disorder
D. Substance-Induced Mania
Correct Answer: B [CORRECT]
